Sunday, August 30, 2009

State funding for mental health and addiction services continues to fall in a shortsighted policy that fails to tackle problems before they escalate into far more costly outcomes.

When legislators descend on Tallahassee in the coming weeks to lay the foundation for next year’s regular session, they should bear in mind that Florida ranks 48th in mental health funding and 35th in alcohol and drug treatment funding — both abysmal national marks for a state 15th in per capita wealth.

When families in crisis cannot secure behavioral health services, they often end up in emergency rooms, behind bars or out on the streets.

And when budget cuts force the closure of hundreds of treatment beds throughout the state — including 39 beds at Manatee Glens — the societal problem intensifies.

While medical costs soar — witness the impassioned national debate over universal health care — mental health care funding drops. The state of Florida has not adjusted funding to account for medical inflation in more than two decades, according to Manatee Glens CEO Mary Ruiz.

At what cost?

This summer, Manatee Glens, the county’s hospital for mental health and addiction treatment, closed the Adolescent Recovery Center, for teenagers with substance abuse and mental health problems. Juvenile clients of the center, a residential unit with 16 beds that provided care for six to nine months, must now find services at a center in Sarasota.

Several other Manatee Glens units, which provide a lifeline to thousands of clients, are threatened — including the Children’s Crisis Unit, for those who are a danger to themselves or others, and the Walk-In Center, which serves uninsured families.

Manatee Glens, a not-for-profit institution, does not survive on state funding alone — the county and private money provide a significant share. But, Ruiz says, the state’s portion of the hospital’s annual budget has plunged from 85 percent to 55 percent during her 20-year tenure. The current budget stands at $25 million.

Ironically, Florida’s lone mental hospital, G. Pierce Memorial Hospital in Arcadia, closed in 2002 over a lawsuit that accused the state of shortchanging patients with fatal results — at least 10 patient deaths and injuries to others blamed on underfunding.

Upon closure, those patients were dispatched to various community mental health providers, and Manatee Glens received 26 clients and a promise of state funding. That money has evaporated during legislative budget cuts, and those 26 beds have been lost.

The Pierce lesson has been lost on the Legislature, as has the funding pledge. Are we doomed to repeat the past, with deadly results?

As Florida ponders spending hundreds of millions of dollars on new prison construction as the inmate population surges past 100,000, that question becomes all the more critical.

Earlier this year the Legislature failed to remedy that situation by not passing the Community Mental Health and Substance Abuse Treatment and Crime Reduction Act. The reform bill would have established mental health courts, pre-arrest jail diversion programs and law enforcement crisis intervention teams, among other measures.

Proponents, including the judicial, law enforcement and mental health communities, vow a reintroduction of the bill in the 2010 session.

According to the state Department of Children and Families, Florida spends some $250 million annually to pay for 1,700 forensic hospital beds for inmates with mental illness, and that expenditure is expected to double over the next decade.

Far more significant, though, is the number of inmates with mental illness — 17,000, and that, too, is forecast to double in 10 years. The projected cost for additional prisons, beds and services for that unfortunate growth is a staggering $3.6 billion.

Community-based treatment is key to keeping the mentally ill out of the justice system, the kind that Manatee Glens provides. That’s a more prudent and thrifty way of dealing with this particular problem.

But lawmakers should also address the broader issue, the entire spectrum of mental health services. Children, teenagers and adults should not be denied treatment for want of funding, else they, too, get caught up in the legal system or otherwise become a burden on society — by overcrowding emergency rooms or roaming the streets.

Even now, too many Manatee families are falling through the cracks. Ruiz says Manatee Glens serves one out of 30 families here, but with appropriate funding could help one out of 10.

The Legislature’s shortsighted policies of the past must be abandoned in favor of a big-picture, humanitarian vision.